While nonalcoholic fatty liver disease is a leading cause of end-stage liver disease, most patients with nonalcoholic fatty liver disease do not develop cirrhosis and its complications. Therefore, risk stratification using inexpensive, noninvasive screening modalities is critical to avoid overdiagnosis and overtreatment of a large proportion of the population. In this review, we discuss the data supporting screening and current professional society recommendations on this topic. Screening for at-risk nonalcoholic fatty liver disease is recommended in patients with risk factors including diabetes, the metabolic syndrome, hepatic steatosis, and elevated aminotransferases. Screening typically consists of noninvasive testing using serum biomarkers followed by elastography using specialized imaging modalities. This sequential screening approach accurately identifies both high- and low-risk patients and is cost-effective when applied to at-risk populations. In conclusion, screening for advanced nonalcoholic fatty liver disease in the primary care setting is a crucial part of identifying high-risk patients who may benefit from aggressive intervention while avoiding overtreatment of patients at low risk of liver-related complications.

虽然非酒精性脂肪肝是终末期肝病的主要原因，但大多数非酒精性脂肪肝患者不会发展为肝硬化及其并发症。因此，使用廉价、无创的筛查方式进行风险分层对于避免大部分人群的过度诊断和过度治疗至关重要。在这篇综述中，我们讨论了支持筛查的数据和当前专业协会关于该主题的建议。建议对存在糖尿病、代谢综合征、肝脂肪变性和转氨酶升高等危险因素的患者进行高危非酒精性脂肪肝筛查。筛查通常包括使用血清生物标志物进行无创测试，然后使用专门的成像方式进行弹性成像。这种顺序筛查方法可以准确识别高风险和低风险患者，并且在应用于高风险人群时具有成本效益。总之，在初级保健机构中筛查晚期非酒精性脂肪肝是识别高危患者的关键部分，这些患者可能受益于积极的干预，同时避免肝脏相关并发症低风险患者的过度治疗。